CHARLESTON, W.Va. — Nearly 2,000 people in five states and Washington, D.C., were urged to get hepatitis B tests after patients and volunteers at a free dental clinic in West Virginia contracted the blood-borne disease, public health officials said Friday.

Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

Officials say the risk of widespread illness is low, but they are concerned that low-income people who can't afford medical care may not know they are sick and could pass the disease to others.

"The problem comes if there has been unrecognized transmission and someone is chronically infected," said Danae Bixler, with the West Virginia Bureau of Public Health. "They need to know that."

Letters recommending testing are being mailed to 1,137 patients who received care at the Mission of Mercy Dental Clinic in Berkeley County in June 2009, according to the agency. Another 826 volunteers are getting similar letters. Most are going to West Virginians, but people from Washington, D.C., Virginia, Maryland, Pennsylvania and North Carolina also are being told to get tested.

The majority of the patients and volunteers are from West Virginia, but the two-day Eastern Panhandle event attracted participants from neighboring states.

Three patients and two volunteers developed acute hepatitis B in November. While the agency says it's not certain they caught the disease at the clinic, tests show four were probably infected by the same source.

About 90 percent of people who get hepatitis B recover, but 10 percent get a chronic form of the disease that can cause liver damage.

The state of West Virginia is expected to pay for the bulk of the testing, including for people who have health insurance, said Berkeley County Health Officer Diana Gaviria.

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